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Cincinnati,
Ohio45229

Purpose:

Reduction of the spinal cord injuries during scoliosis surgery is a major goal of the
anesthesia and surgical team. Despite improvement in scoliosis surgery over the years, the
development of neurological deficits remains the most feared complication of spine surgery.
During scoliosis surgery it is very important to monitor the spinal cord to detect spinal
cord injury with surgical manipulation. Continuous or intermittent intraoperative
electrophysiological monitoring (neuron-monitoring) is used routinely during these
procedures to provide the surgeon with information concerning the integrity of neurological
structures at risk. All neuron-monitoring modalities are affected by the anesthetic regimen
used. Of the various intravenous anesthetic drugs, the combination of propofol, remifentanil
and dexmedetomidine appear to impact neuron-monitoring the least. The current anesthetic
practice is to use the three drugs in combination at doses that do not depress the signals
but there is no data relating targeted dexmedetomidine and propofol blood levels to
neuron-monitoring signals. The lack of data results in wide variability in dosing with
consequent variability in patient response.
Hypothesis: Clinically relevant blood levels of dexmedetomidine will affect the amplitude of
transcranial motor-evoked potentials (TcMEP) either independently or by interaction with
propofol in a dose dependent manner.

Criteria:

Inclusion Criteria:
- Subjects must be 10 to 25 years of age
- Diagnosis of idiopathic scoliosis is established
- Subject's legal authorized representative has given written, informed consent to
participate in the study and, where appropriate, the subject has given assent to
participate
- American society of Anesthesiology physical status one/two
- Patients scheduled for posterior spinal fusion only
Exclusion Criteria:
- • Patients with neuromuscular scoliosis and patients with motor or sensory deficit
in the lower extremities
- Patients with allergy to, or contraindication for the drugs or techniques used
in the study
- Morbid obesity (Body mass index higher than 40)
- History of malignant hyperthermia
- Patient with severe cardiopulmonary disease (pulmonary hypertension,
cardiomyopathy, mechanical ventilation)